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Combined CT Colonography and 18F-FDG PET of Colon Polyps: Potential Technique for Selective Detection of Cancer and Precancerous Lesions

¹ Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Ave., Rm. C276F, New York, NY 10021.
² Department of Nuclear Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY 10021.
³ Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY 10021.
⁴ Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY 10021.
⁵ Department of Radiology, Weill Medical College, Cornell University, New York, NY 10021.

View larger version (105K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1A —79-year-old woman with known 18-mm carcinoma of sigmoid colon. Prone axial CT colonographic scan shows tumor (arrow).

View larger version (83K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1B —79-year-old woman with known 18-mm carcinoma of sigmoid colon. Fluorine-18 FDG PET scan at level of tumor shows focal increased FDG uptake (arrow) in sigmoid colon.

View larger version (97K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1C —79-year-old woman with known 18-mm carcinoma of sigmoid colon. Supine axial CT colonographic scan shows tumor (arrow).

View larger version (86K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1D —79-year-old woman with known 18-mm carcinoma of sigmoid colon. Fused image shows excellent superimposition of polyp and PET signal.

View larger version (57K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2A —20-year-old man with familial adenomatous polyposis and innumerable small colon polyps. CT colonographic scan captured from workstation shows focal polyp (arrow).

View larger version (87K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2B —20-year-old man with familial adenomatous polyposis and innumerable small colon polyps. CT colonographic-PET fusion image captured from workstation shows focal polyp (arrowhead) and perfectly superimposed PET signal corresponding to 6-mm lesion (crosshairs).

View larger version (103K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3A —59-year-old man with known multiple polypoid lesions of colon. PET scan shows no 18F-FDG uptake. Linear activity (arrow) is evident in collapsed small bowel. FDG uptake also was not found on adjacent images.

View larger version (95K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3B —59-year-old man with known multiple polypoid lesions of colon. CT colonographic scan corresponding to A shows 2-cm polyp (arrow) in distal transverse colon.

View larger version (90K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3C —59-year-old man with known multiple polypoid lesions of colon. CT colonographic scan shows 2-cm polyp (arrow) in proximal transverse colon.

View larger version (97K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3D —59-year-old man with known multiple polypoid lesions of colon. PET image corresponding to A-C shows no FDG activity (arrow).

View larger version (94K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3E —59-year-old man with known multiple polypoid lesions of colon. CT colonographic scan 1.8 cm caudad to D shows no lesion (arrow).

View larger version (92K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3F —59-year-old man with known multiple polypoid lesions of colon. PET image corresponding to E shows uptake (arrow) at different level, likely because of anterior abdominal wall motion from breathing. Uptake therefore represents polyp in C with signal shifted 1.8 cm.

View larger version (156K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3G —59-year-old man with known multiple polypoid lesions of colon. Endoscopic view shows proximal polypoid lesion (tubular adenoma) of transverse colon, which was FDG-avid.

View larger version (151K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3H —59-year-old man with known multiple polypoid lesions of colon. Endoscopic view shows distal polypoid transverse colon lesion (tubular adenoma), which was not FDG-avid.

View larger version (95K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4 —80-year-old woman with right colon cancer and multiple serrated adenomas detected at biopsy. Coronal PET image shows multiple foci of 18F-FDG uptake (arrows) corresponding to serrated adenomas in transverse colon.

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